Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Continuous application of transdermal nitroglycerin appears to result in tolerance to the antianginal effect. In a double-blind study the effects of continuous (24 h/day) and intermittent (16 h/day) application of transdermal nitroglycerin in a dosage of 10 mg/day were compared with the effects of placebo in 12 patients with chronic stable angina receiving treatment with beta-adrenergic blocking or calcium channel blocking agents. Exercise performance was assessed 2 to 4 hours after initial application and after 1 week of each treatment given in random order with a 3 day interval between treatments. Exercise time to onset of angina, total exercise duration and time to 1 mm ST segment depression were all significantly increased after initial application during the continuous and intermittent treatment periods. These increases were maintained after 1 week of intermittent but not continuous treatment. Thus the benefit of initial application of transdermal nitroglycerin is maintained with intermittent treatment and a daily nitrate-free interval, whereas tolerance to antianginal effect occurs with continuous treatment.
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PMID:Transdermal nitroglycerin in angina pectoris: efficacy of intermittent application. 311 51

ST-segment analysis on 24-hour Holter ECG was performed in 64 patients with angiographically proven coronary artery disease, a positive exercise test and chronic stable angina. During 125 days of recording, 494 episodes of transient ST-segment depression were observed, at an average of 4.0 +/- 3.7 episodes (1-13 episodes, median: 3 episodes) per day. The duration of ST depression per episode was 13.2 +/- 14.4 min (1-90 min; median: 8 min). No episodes of ST-elevation were observed. Only 27 (5.5%) ischemic episodes occurred during the night, between midnight and 6:00 a.m., but they were frequently observed during the morning hours between 7:00 and 12:00 a.m. Nearly all episodes of ischemia were preceded by an increase in heart rate. However, heart rate at the onset of significant ST-segment depression was significantly lower during Holter monitoring than during exercise test (p less than 0.001); this indicates that factors additional to the increase in myocardial demand might be relevant for transient myocardial ischemia during daily life. 382 of the 494 episodes (77.3%) of ischemia were asymptomatic; heart rate at the onset of ST-segment depression was similar in symptomatic and asymptomatic episodes; however, in asymptomatic episodes, maximal heart rate was significantly lower (p less than 0.001) and the duration of the episodes significantly longer (p less than 0.001). The percentage of asymptomatic episodes was very high in patients with one-vessel disease, whereas the duration and amount of ST-segment depression, as well as heart rate, at the onset of ischemia, were not dependent on the extent of coronary artery disease.
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PMID:[ST segment analysis in 24-hour long-term ECG in patients with stable angina pectoris and angiographically detected coronary sclerosis]. 312 29

Fifteen patients aged 55 +/- 6 years (mean +/- SD) with mild, chronic stable angina were evaluated after 2 weeks of sublingual nitroglycerin therapy (control) and also after 12 weeks of treatment with either propranolol, up to 320 mg per day, or nifedipine, up to 120 mg per day, in order to measure signs of ischemia and the response of symptoms to therapy. Compared with the control period, there was a decrease in average daily episodes of angina from 1.0 +/- 0.8 to 0.5 +/- 0.4 with treatment (p = 0.10). There was a significant decrease of greater than or equal to 1.0 mm ST segment depression (both symptomatic and asymptomatic), from 6.1 +/- 6.5 to 1.5 +/- 2.4 episodes per 24 hours, p less than 0.001, and of asymptomatic episodes of ST segment depression, from 3.5 +/- 3.9 to 1.0 +/- 2.1 episodes per 24 hours, p = 0.03. The number of patients who had any episodes of greater than or equal to 1.0 mm ST segment depression on their 24-hour ECG decreased from 14 to 6 (93% to 40% of patients, p = 0.005) with treatment, and the number of patients with any episodes of ST segment depression without symptoms decreased from 11 to 5 (73% to 33% of patients, p = 0.07). There was an insignificant increase in treadmill time from 333 +/- 134 to 380 +/- 156 seconds, and an insignificant decrease in maximum double-product from 16,631 +/- 3,599 to 14,922 +/- 4,086; the number of patients with angina at maximum exercise decreased from 13 to 10 (87% to 67%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of pharmacologic therapy on angina frequency, ST segment depression during ambulatory ECG monitoring, and treadmill performance in patients with chronic stable mild angina. 312 46

The antianginal efficacy of the transdermal nitroglycerin patch may be limited by the rapid development of tolerance during uninterrupted exposure. To address this problem, we investigated the role of intermittent therapy was investigated, using a daily nitroglycerin patch-free interval in 13 patients with chronic stable angina. Concomitant antianginal medications were permitted. Entry criteria required reproducible exercise times to both onset of angina and 1 mm of ST-segment depression. In each patient the highest tolerated nitroglycerin patch dose was determined by a dose-titration phase, which was then used in a double-blind crossover trial comprising 2 randomized treatment arms: 1 week of active nitroglycerin patch and 1 week of matching placebo. All patches were worn only from 8 A.M. to 10 P.M. daily. Exercise testing was repeated before patch application and then 4 and 8 hours after application on both the first and the last day of each treatment arm. Eleven patients completed the randomized crossover phase. Exercise time to the onset of angina and to the onset of 1 mm of ST-segment depression was significantly prolonged during the first day of therapy at both 4 and 8 hours after active nitroglycerin patch application compared with placebo (p less than 0.01). During sustained use, the benefit at 4 and 8 hours after nitroglycerin patch application was still evident (p less than 0.001 and p less than 0.05, respectively). No evidence of a overnight rebound or withdrawal phenomenon was observed by history or by ambulatory Holter monitoring calibrated for ST-segment analysis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sustained antianginal efficacy of transdermal nitroglycerin patches using an overnight 10-hour nitrate-free interval. 312 49

The acute and chronic efficacy of slow-release isosorbide-5-mononitrate (IS-5-MN) in the form of Elantan long capsules (50 mg) and the tolerability to this agent were evaluated in an open study of 45 patients with chronic stable angina pectoris, treated for one year. After 3 days of replacement of previous antianginal treatment with placebo, an Elantan long capsule (50 mg) was given once daily in the morning. Exercise test was performed 6 hours after ingestion of the capsule, on placebo (after wash-out of 3 days), in the first day of treatment, and after 3 and 6 months of treatment as well as 6 and 24 hours after 12 months of treatment compared to the exercise test at the same time after discontinuation of treatment (three days on placebo). At comparable work load the drug was associated with a 26.6% reduction in ST-segment depression after 6 hours of acute treatment, 46.7% after 3 months of treatment, 52.2% after 6 months, and 66% at the end of treatment (12 months) (P less than 0.001). Even 24 hours after intake of the last capsule of Elantan long the ST-segment reduction was still 49.5%. Exercise test 24 hours after ingestion of the drug revealed that the effect still exists. In the post-treatment placebo period all values returned to pretreatment levels. The sublingual nitroglycerin consumption was reduced by 90% and the frequency of anginal attacks was reduced from 19 +/- 15 to 1.1 +/- 4.2 weekly (P less than 0.001). The drug was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Slow-release isosorbide-5-mononitrate--a new once daily therapeutic modality for angina pectoris. 313 63

Clinical efficacy of 5 mg per 24 hours transdermal nitroglycerin was studied in a placebo controlled, randomized, double-blind crossover trial, with three days wash-out period at the beginning, in 40 patients with chronic stable angina pectoris during two periods of 14 days. Assessment was carried out by means of a diary method, by the multistage treadmill exercise test, five hours after dosing, and by 24-hour ambulatory ECG recordings. Nitroglycerin patch demonstrated significant improvement of exercise tolerance comparing to placebo, in exercise time to the onset of angina pectoris and ST-segment depression of greater than or equal to 1.0 mm (+45% and +47%), in maximum walking time (+13%), as well as in diminished severity of maximum angina (-38%), in lower maximal ST-segment depression (-32%) and in faster recovery of ST-depression 3 and 6 minutes after the test (-28% and -44%). Nitroglycerin patch showed 33% less angina attacks, mainly severe and moderate, resulting in 37% less sublingual nitroglycerin consumption. A significant fall in the number of ST-segment depression episodes of 1.5 mm or more (-60%) was shown in the 24-hour ECG. All these changes were confirmed to be significant compared to placebo values, at a level of P less than 0.01, by multivariate analysis. This study revealed a positive effect of low dose nitroglycerin patch on improvement of exercise functional capacity and signs of myocardial ischaemia after 14 days of continuous therapy.
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PMID:A randomized placebo controlled, double-blind, crossover trial of transdermal nitroglycerin in stable angina pectoris. 313 73

The comparative effects of prolonged chronic therapy with diltiazem, nicardipine, tiapamil and verapamil on exercise tolerance, ST-segment changes and heart rate were examined in 63 patients with established chronic stable angina pectoris. Multistage computer-assisted symptom-limited treadmill exercise tests were performed after 2 weeks of placebo ("baseline") and then after 4 months of open-label chronic drug therapy. Diltiazem improved the exercise duration by 95% (p less than 0.001), nicardipine by 45% (p less than 0.001), tiapamil by 69% and verapamil by 79% (p less than 0.001). Maximal ST-segment depression was not altered by any of the drugs, but time to the development of 1 mm ST-segment depression was significantly improved in all cases. Diltiazem and verapamil reduced the heart rate at rest significantly by 6 and 8 beats/minute, respectively, whereas nicardipine increased it by 10 beats/minute (p less than 0.02), and tiapamil did not produce any significant change. Maximal heart rate at the peak of exercise was increased by 14% with nicardipine (p less than 0.001) and 6% with verapamil (p less than 0.05), whereas diltiazem and tiapamil did not produce any appreciable effect. The rate-pressure product at the peak of exercise remained unaltered with diltiazem, tiapamil and verapamil, but with nicardipine it increased significantly to 222 +/- 10 units from a baseline of 175 +/- 6 units with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparative effects of prolonged therapy with four calcium ion antagonists (diltiazem, nicardipine, tiapamil and verapamil) in patients with chronic stable angina pectoris. 315 12

Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication had been withdrawn for 5 days. There were 196 episodes of ST-segment depression, 145 (74%) of which were not accompanied by angina. As well, a tendency to more prolonged and greater ST-segment change with symptomatic ischaemic episodes was noted. A diurnal variation in transient ischaemia both with and without symptoms was observed, the highest frequency being in the morning hours. Transient myocardial ischaemia was more frequent in patients with double or triple vessel disease, compared with single vessel disease, but with a great variation. Heart rate at the onset of ischaemia during ambulatory monitoring was significantly lower than heart rate at the onset of ST-segment change during exercise testing (100.2 +/- 14.6 vs. 115.8 +/- 19.6 beats/min, p less than 0.01), which may indicate different pathophysiological mechanisms. Transient impairment in coronary oxygen supply seems to be of importance during ischaemic episodes out of hospital.
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PMID:Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris. 318 81

The efficacy of diltiazem in comparison with metoprolol in chronic stable angina was assessed in 33 male patients during a 15-week blind cross-over study. After an initial two-week run-in period, baseline measurements were made. Subsequently, the patients entered a blind cross-over study consisting of two six-week treatment periods with diltiazem 240 mg (60 mg q.i.d.) or metoprolol 200 mg (100 mg b.i.d.). Dose adjustment to either 360 mg diltiazem (120 t.i.d.) or 400 mg metoprolol (200 b.i.d.) was allowed two weeks after the start of treatment. There was a one-week washout period between the two treatment periods. Compared to baseline values both drugs reduced the number of anginal attacks (diltiazem - 55%, P = 0.02; metoprolol - 73%, P = 0.01) and showed improvement of the measured exercise variables (exercise duration: diltiazem + 16%, P less than 0.001; metoprolol + 4%, P = NS; time to angina: diltiazem + 21%, P = 0.02, metoprolol + 14%, P = NS; maximal ST-depression: diltiazem + 13%, P = NS, metoprolol + 33%, P = 0.002). No significant change in LVEF was noticed. Both drugs reduced the mean heart rate on Holter tape (diltiazem - 11%, P = 0.006; metoprolol - 14%, P = 0.004). No effects on conduction were noticed. Although at the borderline of significance, diltiazem increased the total exercise duration as compared to metoprolol (16 vs. 4%, P = 0.05). It is concluded that diltiazem improves exercise tolerance in patients with stable angina pectoris and appears to be a safe and effective alternative to the beta-blocking agent metoprolol.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diltiazem in comparison with metoprolol in stable angina pectoris. 323 11

Despite the widespread use of the exercise stress test in diagnosing asymptomatic myocardial ischemia, exercise radionuclide imaging remains useful for detecting silent ischemia in numerous patient populations, including those who are totally asymptomatic, those who have chronic stable angina, those who have recovered from an episode of unstable angina or an uncomplicated myocardial infarction, and those who have undergone angioplasty or received thrombolytic therapy. Studies show that thallium scintigraphy is more sensitive than exercise electrocardiography in detecting ischemia, i.e., in part, because perfusion defects occur more frequently than ST depression and before angina in the ischemic cascade. Thallium-201 scintigraphy can be performed to differentiate a true- from a false-positive exercise electrocardiographic test in patients with exercise-induced ST depression and no angina. The development of technetium-labeled isonitriles may improve the accuracy of myocardial perfusion imaging.
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PMID:Myocardial perfusion imaging for detection of silent myocardial ischemia. 328 20


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